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support of a health care program for an individual or group of individuals, and which may include access to one or <br />more of Company's provider networks or vendor arrangements, except those excluded by Health Plan, <br />1.8. "Covered Person" means any individual entitled to receive Covered Services pursuant to the terms <br />of a Coverage Agreement. <br />1.9. "Covered Services" means those services and items for which benefits are available and payable <br />under the applicable Coverage Agreement and which are determined, if applicable, to be Medically Necessary under <br />the applicable Coverage Agreement. <br />1.10. "Health Plan" means either CCC or CCW with respect to each Product covered by this Agreement, <br />as specified in accordance with Schedule B to this Agreement or the applicable Product Attachment. <br />1.11. "Medically Necessary" or "Medical Necessity" shall have the meaning defined in the applicable <br />Coverage Agreement and applicable Regulatory Requirements. <br />1.12. "Participating Provider" means, with respect to a particular Product, any physician, hospital, <br />ancillary, or other health care provider that has contracted, directly or indirectly, with Health Plan to provide Covered <br />Services to Covered Persons, that has been approved for participation by Company, and that is designated by <br />Company as a "participating provider" in such Product. <br />1.13. "Payor" means the entity (including Company where applicable) that bears direct financial <br />responsibility for paying from its own funds, without reimbursement from another entity, the cost of Covered Services <br />rendered to Covered Persons under a Coverage Agreement and, if such entity is not Company, such entity contracts, <br />directly or indirectly, with Company for the provision of certain administrative or other services with respect to such <br />Coverage Agreement. <br />1.14. "Pavor Contract" means the contract with a Payor, pursuant to which Company Punishes <br />administrative services or other services in support of the Coverage Agreements entered into, issued or agreed to by <br />a Payor, which services may include access to one or more of Company's provider networks or vendor arrangements, <br />except those excluded by Health Plan. The term "Payor Contract" includes Company's or other Payor's contract <br />with a governmental authority (also referred to herein as a "Governmental Contract") under which Company or Payor <br />arranges for the provision of Covered Services to Covered Persons. <br />1.15. "Product" means any program or health benefit arrangement designated as a "product" by Health <br />Plan (e.g., Health Plan Product, Medicaid Product, PPO Product, Payor-specific Product, etc.) that is now or hereafter <br />offered by or available from or through Company (and includes the Coverage Agreements that access, or are issued <br />or entered into in connection with such product, except those excluded by Health Plan). <br />1.16. "Product Attachment" means an Attachment setting forth requirements, terms and conditions specific <br />or applicable to one or more Products, including certain provisions that must be included in a provider agreement <br />under the Regulatory Requirements, which may be alternatives to, or in addition to, the requirements, terms and <br />conditions set forth in this Agreement. <br />1.17. "Regulatory Requirements" means all applicable federal and state statutes, regulations, regulatory <br />guidance, judicial or administrative rulings, requirements of Governmental Contracts and standards and requirements <br />of any accrediting or certifying organization, including, but not limited to, the requirements set forth in a Product <br />Attachment. <br />1.18. "State" is defined as the State of Washington. <br />PPA WA - Kittitas County Public Ilealth - 05.07.2025 - ICMProviderAgrecment_360268 Page 2 of 24 <br />